Radial free forearm flap rfff surgical technique vula. The standard dissection for radial forearm free flap harvest has been described in detail elsewhere. The defect was reconstructed with a free radial forearm flap with fascia suspended on a titanium mesh. Revisiting radial forearm free flap for successful venous drainage.
Radial forearm flap is the most common type of ftm phalloplasty. Rfff has two major venous outflow systems, superficial and deep vein. After tumor resection is complete, the hyoid bone is elevated as an osteomuscular flap and sutured to the remaining stump of the epiglottis see image below. Inflatable penile prosthesis technique and outcomes after. The forearm flap is a fasciocutaneous flap based on the fasciocutaneous perforators from the radial artery. The radial forearm flap is supplied by the radial artery and perforators from the. The radial forearm flap is supplied by the radial artery and perforators from the radial artery to the overlying skin.
This reconstructive technique enabled us to maintain the integrity of the subglottic airway. The radial free forearm flap rfff was one of the first free tissue transfer flaps to be described. This is due to the nature of the skin of the forearm areas on the underside of the forearm are of good consistency and often are fairly hairless as well as the nerves and. Radial forearm free flap rfff is a versatile reconstructive method, first described by yang et al. The patient maintains a total oral diet with a gastrostomy tube and has 100% sentence intelligibility.
The radial forearm free flap is a viable reconstructive option for tongue defects. Closure of radial forearm free flap donor site defect with a local meshed fullthickness skin graft. A patient with a beavertail modified radial forearm free flap used to reconstruct a total oral tongue defect at 3 years after surgery. The radial forearm free flap rfff as a fasciocutaneous flap was developed in 1978 in the peoples republic of china but it was soutar and colleagues in 1983 from scotland who popularized the. Thus, an understanding of free flaps, their expected appearance on crosssectional imaging, and their. Reconstructive surgery for severe penile inadequacy. Radial forearm free flap for soft palate reconstruction. Indications for the use of the procedure the radial forearm flap is a reliable, versatile flap, based on the radial artery, that can be applied to reconstruction of many anatomic structures in. Prepare the operative arm to include the axilla and place towels to separate from head incision.
In 1978, a fasciocutaneous free flap from the volar aspect of the forearm and pedicled on the radial artery was first used in china. Jan 03, 2018 a close variation of this technique uses the radial forearm free flap and hyoid bone flap to recreate the epiglottis. Revisiting radial forearm free flap for successful venous. The most common tissue flap sources for neophallus reconstruction are free flaps derived from the radial forearm, but options also include. With these versatile qualities, the forearm flap has become one of the most frequently used free tissue transfers. Free flaps did not, however, become widely used for hypopharyngeal reconstruction until after the refinement of microvascular techniques during the 1970s. A close variation of this technique uses the radial forearm free flap and hyoid bone flap to recreate the epiglottis. Use of radial forearm free flap with palmaris longus.
Jun 04, 2016 this chapter focuses on the radial forearm flap technique and discusses the ulnar forearm flap as an alternate technique for forearm flap reconstruction. Radial forearm free flap postoperative instructions 3 the hospital staff will be doing doppler checks checking for a pulse in the forearm every hour for the first 24 hours, then every 2 hours for the next 24 hours and then every 4 hours while hospitalized. Harii described the use of a tubed fasciocutaneous free flap for pharyngoesophageal reconstruction in 1985. B, radial forearm free flap design of soft palate oropharyngeal reconstruction. The forearm provides an ideal location for prelamination of the flap prior to transfer. The radial forearm free flap rfff has become the most frequently used surgical technique for a phalloplasty and is superior to all other techniques, because it effectively meets the goal of creating a pleasing and sensate neophallus with a functioning neourethra to allow voiding from the distal end of the neophallus. Thus, an understanding of free flaps, their expected appearance on crosssectional imaging, and their associated complications. The radial forearm free flap was inset, and the radial artery and cephalic veins were anastomosed to the right superior thyroid artery and external jugular vein, respectively. It has since become a work horse for soft tissue replacement in. Drape prepare the head and neck separately from the arm. Radial forearm free flap iowa head and neck protocols.
The radial forearm free flap is ideal for reconstruction of defects of the. The standard dissection for radial forearm freeflap harvest has been described in detail elsewhere. Drainage methods include combining both systems or using one alone. The most common tissue flap sources for neophallus reconstruction are free flaps derived from the radial forearm, but options also include tissue from the anterolateral thigh, the scapula. Head and neck surgical reconstruction is complex, and postoperative imaging interpretation is challenging. Beavertail modification of the radial forearm free flap in base of tongue reconstruction. The number of perforators is greatest between 12 and 20 cm from the takeoff of the radial artery, and these are the vessels captured in the distally located skin paddle.
Radial forearm flap an overview sciencedirect topics. Some patients will have a tracheotomy, it is more common if having a. It is one of the most common ways of replacing tissue in the head and neck, particularly after mouth cancers have been removed. The skin of the volar forearm provides relatively thin and reliable coverage for a. Despite regarding it as the preeminent technique, urological complications remain the ubiquitous challenge of radial forearm phalloplasty. Forearm free flap phalloplasty this procedure is considered by many to produce a more realisticlooking, more erotically sensate phallus than older phalloplasty procedures. It must be a unicortical block of volar radius, and no wider than 1. However, in some cases of partial detachment of the skin graft due to 160 radial forearm free flap donor site outcomes with a new closure technique fig. A radial forearm free flap is one way of filling a hole which is left when a cancer has been removed. Radial forearm free flap surgery is a versatile technique that is widely adopted for microvascular reconstruction of the oral, oropharyngeal and hypopharyngeal lining. A free flap, such as the radial forearm free flap, is the method of choice because of good aesthetic results, low donor site morbidity, and excellent erogenous sensitivity.
Although nearly all of the forearm skin can be taken as a free flap based on the radial artery angiosome, this would be highly morbid because of the disruption of the lymphatic drainage from the hand. In case a free flap is contraindicated, a pedicled flap, such as the anterolateral thigh flap, should be used. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. Radial forearm free flap postoperative instructions. Radial forearm free flap what is a radial forearm free flap. Free radial artery forearm flap in reconstruction of oral cavity cancers our experience 88 int j res med. Radial forearm free flap pharyngoesophageal reconstruction. The radial forearm flap journal of plastic, reconstructive. A, flap size was notably larger for patients who underwent radial forearm free flap rfff compared with those who underwent submental island pedicled flap sipf p may 25, 2017 tissue defect reconstruction using radial forearm free flap rfff is a common surgical technique whose success or failure is mainly dependent on venous drainage.
The dominant pedicle is the radial artery, with venous outflow through the dual system of the venae comitantes and cephalic vein. Beavertail modification of the radial forearm free flap in. Learn about the free radial forearm flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. Urological complications, however, can arise quite frequently and can prevent the patient from urinating in the standing position, an important postsurgical goal for many. This is surgery that removes a piece of skin from your inner forearm and uses it to replace tissue that was removed due to cancer. To reconstruct the total maxillectomy defect, a radial forearm free flap with the palmaris longus tendon was elevated to inlay the nasal cavity and the oral cavity and to suspend the ocular globe. A, postoperative appearance 5 years after a radial forearm free flap donor site. Reconstructing forearm free flap donor sites using full. Nov 22, 2011 radial forearm free flap surgery is a versatile technique that is widely adopted for microvascular reconstruction of the oral, oropharyngeal and hypopharyngeal lining. Prep and drape radial forearm free flap standard prep, 10% providone iodine. Plastic surgeon aesthetic and reconstructive surgery microsurgery tsimiski 99 str. The radial forearm flap is usually used in reconstruction of the mutilated hand as a reverse pedicled flap, but occasionally, a free radial forearm flap can be harvested from the contralateral forearm. It has since become a work horse for soft tissue replacement in head and neck cancer surgery, being commonly used to replace external skin and internal mucosal linings. Hinged forearm splitthickness skin graft for radial.
The venae commitans of the radial artery or the cephalic vein can be used for venous drainage. Yang and gao of the shenyang military hospital initially introduced the radial forearm flap, often called the chinese flap. The flap was placed into the defect, and the palmaris longus tendon was medially and laterally anchored to the periosteum of the frontal bone to. Prelamination of neourethra with uterine mucosa in radial. This chapter focuses on the radial forearm flap technique and discusses the ulnar forearm flap as an alternate technique for forearm flap reconstruction.
Though many techniques have been described, the radial forearm free flap remains the most common for phalloplasty due to its long, reliable vascular pedicle, multiple nerve innervations, and pliability 1. The radial forearm free flap is the preferred technique for total phalloplasty. Radial forearm free flap fasciocutaneous hns preferences. An atlas of microsurgery techniques and principles. Hinged forearm splitthickness skin graft for radial artery. The donor site is thin and supple allowing the flap to be easily tubed and shaped into a penis, and the relatively hairless skin provides erogenous sensation and allows urethral reconstruction in a single stage. The forearm fasciocutaneous flap based on the radial or ulnar artery is a favored flap in microvascular head and neck reconstruction because of its pliability, its reliability of harvest, and its versatility. A, defect of the base of tongue, tonsillar fossa, and two thirds of the soft palate resulting after treatment of right tonsil cancer. Doctors often use this surgery to reconstruct an area in the head and neck. The radial forearm, lateral arm and the latissimus dorsi flap have the highest reported rates of survival among the most commonly performed free flaps.
Radial forearm flap british association of oral and. During this surgery, the radial forearm flap was harvested with a cuff of brachioradialis muscle to facilitate contouring of the reconstructed right tongue. Several types of free flaps can be used to restore defects within the oral cavity and orohypopharynx anterolateral thigh flap, rectus abdominis musculocutaneous flap, free deltoid flap, etc. A new bilobed design for the sensate radial forearm flap to preserve tongue mobility following significant glossectomy. Imaging of surgical free flaps in head and neck reconstruction. This flap is the most commonly used fasciocutaneous flap for reconstruction of defects in the head, neck, and limbs. Tissue defect reconstruction using radial forearm free flap rfff is a common surgical technique whose success or failure is mainly. This problem usually responds readily to wettodry dressings and rarely requires debridement or regrafting. It is sufficiently thin and well vascularized to be an ideal means of providing tissue for large defects that cannot be resurfaced with mucosal grafts. Surgeons now use microvascular free tissue transfer, also known as free flaps, more frequently in head and neck reconstruction than ever before. Jan 03, 2017 the radial forearm free flap rfff has become the most frequently used surgical technique for a phalloplasty and is superior to all other techniques, because it effectively meets the goal of creating a pleasing and sensate neophallus with a functioning neourethra to allow voiding from the distal end of the neophallus. The use of a prefabricated radial forearm free flap for. This technique was introduced to give the advantage of the radial forearm phalloplasty without the need for an additional stiffener. Successful anastamosis was confirmed with bleeding observed at the edges of the free flap.
Shortly after, this technique was popularized by different european. Anastamosis of the radial artery of the flap was performed to the nearby mandibular artery. It can be used to replace large parts of the mouth and has the advantage that when it heals it. Microvascular techniques have allowed surgeons to readily transfer. It is one of the most common ways of replacing tissue in. The patient did not complain about the appearance and function of the left forearm. Submental island pedicled flap vs radial forearm free flap. Cricotracheal reconstruction with free radial forearm flap. Radial forearm flap rfff with standard full thickness skin graft ftsg.
Osteocutaneous radial forearm flap free tissue transfer. Cadaveric studies performed in 1978 identified this flap and subsequent clinical series published in the chinese literature in 1981 sealed it as a viable reconstructive option. Surgical technique ottie van zyl the radial free forearm flap rfff was one of the first free tissue transfer flaps to be described. Radial forearm flap microsurgery made easy loading. Using mucosa to construct the fixed urethra and to. The free radial forearm fascial flap has not previously been described for reconstruction of the intranasal passage, to our knowledge. When this socalled chinese flap was originally described by yang et al. Revisiting radial forearm free flap for successful venous drainage yong hoon cha, woong nam, inho cha and hyung jun kim abstract tissue defect reconstruction using radial forearm free flap rfff is a common surgical technique whose success or failure is mainly dependent on venous drainage.
As with the fasciocutaneous radial forearm free flap fcrfff, the most common donor site complication is poor splitthickness skin graft stsg take over the flexor carpi radialis tendon. Inflatable penile prosthesis technique and outcomes after radial forearm free flap neophalloplasty. B, radial forearm freeflap design of soft palate oropharyngeal reconstruction. Free radial artery forearm flap in reconstruction of oral. It has since become a workhorse for soft tissue replacement in head. Nowadays, the technique for harvesting is standardized, while reconstruction of the forearm donor site defect is somewhat controversial. Radial forearm free flap phalloplasty is the most commonly performed flap for neophallus construction in the femaletomale ftm transgender patient. Tissue defect reconstruction using radial forearm free flap rfff is a common surgical technique whose success or failure is mainly dependent on venous drainage. The reverse radial forearm rrf flap can be used to cover moderatesized defects of the dorsal or volar hand extending to the metacarpophalangeal joints as well as for treatment of median nerve neuromas.
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